gms | German Medical Science

62nd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Polish Society of Neurosurgeons (PNCH)

German Society of Neurosurgery (DGNC)

7 - 11 May 2011, Hamburg

Cranial dural arteriovenous fistulas: An interdisciplinary approach

Meeting Abstract

  • T. Martens - Klinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
  • J. Regelsberger - Klinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
  • T. Ries - Klinik für Neuroradiologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
  • J. Fiehler - Klinik für Neuroradiologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
  • M. Westphal - Klinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf, Hamburg

Deutsche Gesellschaft für Neurochirurgie. Polnische Gesellschaft für Neurochirurgen. 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH). Hamburg, 07.-11.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocMO.10.10

DOI: 10.3205/11dgnc075, URN: urn:nbn:de:0183-11dgnc0757

Published: April 28, 2011

© 2011 Martens et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

Text

Objective: Cognard Type II-IV cranial dural arteriovenous fistulas (cDAVF) bear the risk of disasterous intracranial hemorrhage. These fistulas are characterized by retrograde venous drainage into a dural sinus or a cortical vein. The treatment of DAVF consists of endovascular embolization, microsurgery or a combination thereof. The results of our single center experience with a multimodal approach are presented.

Methods: Patients with DAVF treated at our center between 2002 and 2010 were identified by retrospective chart review. Clinical symptoms, location, Cognard grade, treatment modality or combination and occlusion rates were analyzed.

Results: cDAVF were diagnosed in 67 patients at our center between 2002 and 2010. The patients presented with tinnitus (n=25), headache or dizziness (n=17), intracranial hemorrhage (n=11), transient ischemic attack (n=10) and seizures (n=4). All patients underwent digital subtraction angiography (DSA) and DAVF were detected in the following locations: transverse / sigmoid sinus (n=36), tentorial (n=17), parasagittal (n=7), dura of the anterior fossa (n=4) and dura of the middle fossa (n=3). 16 patients were classified as Cognard grade I, 44 as grade II, four as grade III, two as grade IV and one as grade V. 39 patients were treated endovascularly, 12 patients received no specific treatment and 8 patients underwent surgical treatment initially. Another 8 patients underwent microsurgical occlusion of the fistula after the endovascular approach did not result in complete obliteration as follows: persisting fistula after endovascular approach (n=4), complications of the endovascular procedure that resulted in the need for further surgical treatment of the fistula (n=3) and technical reasons (n=1). The primary occlusion rate of the operated patients was 94%, whereas the overall occlusion rate of all patients treated was 75%.

Conclusions: The endovascular approach is the first choice of treatment for most cDAVF. Surgical occlusion of the fistula is an important option with excellent results either as first-line treatment in selected cases (Cognard Type II-V) or as a combined approach after endovascular methods have failed.